Case presentation on Quadriparesis with Guillain barre syndrome Quadriparesis is a condition characterized by weakness in all four limbs (both arms and both legs). The weakness may be temporary or permanent. Quadriparesis is different from quadriplegia. In quadriparesis, a person still has some ability to move and feel their limbs. In quadriplegia, a person has completely lost the ability to move their limbs.

1. CASE PRESENTATION ON
QUADRIPARESIS WITH GUILLAIN BARRE
SYNDROME
PRESENTATION BY :
M.TEJASHREE
PHARM D 4TH YEAR
ANURAG PHARMACY COLLEGE
SURYAPET

2. INTRODUCTION
• Quadriparesis is a condition characterized by
weakness in all four limbs (both arms and both
legs).
• It’s also referred to as tetra paresis. The
weakness may be temporary or permanent.
• Quadriparesis is different from quadriplegia.
• In quadriparesis, a person still has some ability
to move and feel their limbs.
• In quadriplegia, a person has completely lost the
ability to move their limbs.

3. CAUSES
• Infection : liKe Viruses and bacteria
• Toxins/drugs :
• alcohol poisoning or chronic alcohol abuse
• heavy metal poisoning
• snake venom
• scorpion sting
• tick paralysis
• botulism
• certain chemotherapy treatments
• a neuromuscular disease, like muscular dystrophy
• damage to the nervous system due to an injury or another medical condition
• Other medical conditions :
• Guillain-Barré syndrome
• locked-in syndrome
• myasthenia gravis
• Injury/trauma to the spine

4. • SYMPTOMS:
• The main symptom of quadriparesis is weakness in all four limbs.
• A person with quadriparesis will have difficulty controlling the muscles in the affected body
parts.
• Other symptoms may include:
• limb muscles that lack firmness (flaccid quadriparesis)
• unusual stiffness or tightness of the muscles (spastic quadriplegia)
• lack of motor control
• inability to walk
• loss of bladder control
• depressed reflexes

5. PATHOPHYSIOLOGY
Destruction of
nervous tissue
parenchyma
from causative
effects
Compression/
stain/
occlusion on
brain artery
Ischaemia on
spinal arteries
Dec blood flow
to brain and
spinal artery
Loss of
sensation and
control of
limbs
Leads to
quadriparesis

6. DIAGNOSIS
• MRI scan of the brain and spine, to see if you have a tumor or herniated disc.
• Electromyography (EMG), a nerve function test that reads electrical activity from the muscles
(EMG can help your doctor differentiate between can muscle and nerve disorders.)
• nerve conduction studies to see how well your nerves and muscles respond to small
electrical pulses
• lumbar puncture (spinal tap) to collect and analyse your cerebrospinal fluid (CSF)
• muscle or nerve biopsies, when a small sample of muscle or nerve is removed for further
testing in a laboratory

7. GUILLAIN BARRE SYNDROME
• Guillain-Barre Syndrome is a problem with your nervous system.
• It can cause muscle weakness, reflex loss, and numbness or tingling
in parts of your body. It can lead to paralysis, which is usually
temporary.
• It is acute inflamatory Demylinating Polynuropathy characterized
progressive muscle weakness and areflexia.
• Causes :
• 30% of cases are provoked by Campylobacter jejuni bacteria
• Autoimmune disorders
• Already affected with paralysis

8. PATHOPHYSIOLOGY
Immune system begins attack neural tissue
Myelin sheath is destroyed
Nerve conduction slowed or may blocked
Schwann cells that produce myelin in peripheral nervous system are
destroyed
Demyelination of myelin on axons
GUILLAIN BARRE SYDROME

9. SIGNS AND SYMPTOMS
• Numbnes and tinglins
(parathesia), and pain, alone or
in combination.
• weakness of the legs and arms
that affects both sides
• The weakness can take half a
day to over two weeks to reach
maximum severity, and then
becomes steady
• weakness of the muscles of the
face, swallowing difficulties and
sometimes weakness of the eye
muscles.

10. DIAGNOSIS
• LUMBAR PUNCTURED : elevated levels of protein in CSF fluid
• ELECTROMYOGRAM (EMG) : Nerve response
• NERVE COUNDUCTION VELOCITY : Speed of signals

11. SUBJECTIVE DATA
• Patient information :
• Pt name : XXXX
• Age / gender : 40/M
• ADMISSION NO : 1910011475
• DEPT : MMW-2
• DOA :1/10/19
• CHIEF COMPLAINTS : c/o weakness of upper and lower limbs since 20days, change in
colour of urine, c/o HEMATURIA since 15 days.
• HISTORY OF PRESENT ILLNESS : pt developed weakness in both the limbs and c/o tingling
sensation
• PAST MEDICAL HISTORY : Mouth deviation H/O right sided hemiparesis 8yrs back, difficulty
in holding object, mixing food, standing.
• PERSONAL HISTORY : Alcoholic regular, Tobacco 2 packs/day
• TREATMENT HISTORY : Hypothyroidism on regular medication (2yrs)

12. • PHYSICAL EXAMINATION :
• BP : 140/100mm/Hg
• TEMP : 98.6 F
• PULSE RATE : 84/min regular in rhythm
• RR : 18/min
• SYSTEMIC EXAMINATION :
• CVS : S1 S2 +
• R/S NVBS +
• P/A : SOFT, NON tender
• Nervous system examination :
• pt conscious, speech normal, cranial nerves normal.

13. OBJECTIVE DATA

14. • EXAMINATION OF MOTOR SYSTEM :
• TONE : reduced tone in all limbs
• POWER : upper limb (shoulder)
FLEXORS
EXTENSORS
ADDUCTORS
ABDUCTORS
• POWER : elbow
FLEXORS
EXTENSORS
• POWER : wrist
FLEXOR
EXTENSOR
• HAND GRIP :not able to hold fingers
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5

16. • POWER : Lowerlimb (hip)
FLEXOR
EXTENSOR
ADDUCTORS
ABDUCTORS
• KNEE
FLEXIOR
EXTENSION
• ANKLE
PLANTAR FLEXION
DORSAL FLEXION
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5
3/5 3/5

17. • DEEP TENDON REFLEXES
BICEPS
TRICEPS
SUPINATOR
KNEE
ANKLE
+1 +1
+1 +1
+1 +1
+1 +1
(-) (-)

18. LABORATORY REPORTS
PARAMETERS 1/10/19 2/10/19 3/10/19 4/10/19 NORMAL RANGE
HAEMOGLOBIN 10.9gm% 10.8gm% 11gm% 11.7gm% M: 13.5-17.5gm%
T.RBC 3.64mill/cmm 3.76mill/cmm 3.87mill/cmm 3.9mill/cmm M: 5.0mill/cmm
ESR 30mm/hr 30mm/hr 20mm/hr 19mm/hr 0-25mm/hr
LIVER
GLOBULINS
4.2gm/dl - - - 2-3.5gm/dl
SGOT (AST) 124 IU/L - - -- < 49 IU/L
SGPT (ALT) 303 IU/L - - - < 49 IU/L
CSF PROTEIN - 65mg/dl - - 15-60mg/dl
Total cholesterol 205mg/dl 200mg/dl
Triglycerides 165mg/dl 150mg/dl
HDL chol 22mg/dl 40-59mg/dl
LDL chol 134mg/dl 100-129mg/dl

19. INVESTIGATIONS
• CT SCAN
• Multiple lacunae In both basal ganglia
and left periventricular region.
• THYROID PROFILE TEST
TOTAL TRI
IODOTHYRONINE (T3)
0.7ng/mL 0.58-1.62ng/ml
TOTAL THYROXINE (T4) 9ug/mL 4.0-11.5ug/mL
TSH 6.7uIU/mL 0.35-5.1uIU/mL

21. TREATMENT HISTORY
S.N
O
BRAND NAME ACTIVE
COMPOSITION
DOSE ROA FRQ INDICATION SIDE
EFFECTS
START
DATE
STIP
DATE
1. Normal saline
OPTINURON
Thiamine vit B1 100m
g/ml
IV 12hrs Vit B1
supplyment
Mild
diarrhea
1/10/19 5/10/
19
2. T.HAPISIP Minerals, vits,
Calcium prepn
1 tab PO OD VIT supplyment Stomach
upset
1/10/19 5/10/
19
3. T.ECOSPRIN-AV Aspirin(150mg)
Atorvastatin(10mg)
160
mg
PO OD Antiplatelet &
Dyslipidemia
Heart pain
Abd pain
1/10/19 5/10/
19
4. T.CLOPITAB clopidogrel 75mg PO OD Antiplatelet Redness
skin
1/10/19 4/10/
19
5. INJ. DECADRON Dexamethasone 2cc IV 8th
hrly
Anti
inflammation,
cerebral edema
Dizziness
headache
1/10/19 5/10/1
9
6. T.THYRONORM Thyroxine sodium 100
ug
PO BD hypothyroidism Chest pain
Rapid heart
beat
4/10/19 Cont….
7. T.PAN Pantoprezole 40mg PO OD Gastric reflux Headache
dizziness
5/10/19 Cont..
8. Physiotherapy Regularly

22. INTERVENTIONS
• Prescription is irrational
• Interactions : ASPIRIN + CLOPIDOGREL
• Increases toxicity by pharmacodynamic synergism.
• Interactions : PANTOPREZOLE + THYROXINE
• Increases gastric Ph

23. DAY TO DAY PROGRESS
DAY 1 :
TEMP: 98 .6 F
BP:140/100 mmHg
PR: 82 bpm
RR: 18/min
 upper limb (shoulder) power 3/5
 ELBOW: 3/5
 WRIST: 3/5
 LOWER LIMB(HIP) : 3/5
 KNEE: 3/5
 ANKLE: 3/5
DAY 2 :
TEMP: afebrile
BP:130/90 mmHg
PR: 84 bpm
RR: 18/min
 upper limb (shoulder) power 4/5
 ELBOW: 3/5
 WRIST: 3/5
 LOWER LIMB(HIP) : 3/5
 KNEE: 3/5
 ANKLE: 3/5

24. DAY TO DAY PROGRESS:
DAY 3 :
TEMP: afebrile
BP:120/80 mmHg
PR: 78 bpm
RR: 18/min
 upper limb (shoulder) power 4/5
 ELBOW: 4/5
 WRIST: 4/5
 LOWER LIMB(HIP) : 4/5
 KNEE: 4/5
 ANKLE: 3/5
DAY 4 :
TEMP: afebrile
BP:140/90 mmHg
PR: 78 bpm
RR: 18/min
 upper limb (shoulder) power 4/5
 ELBOW: 5/5
 WRIST: 5/5
 LOWER LIMB(HIP) : 4/5
 KNEE: 5/5
 ANKLE: 4/5

25. DISCHARGE SUMMARY
TEMP: afebrile
BP:120/80 mmHg
PR: 78 bpm
RR: 18/min
upper limb (shoulder) power 4/5
ELBOW: 5/5
WRIST: 4/5
LOWER LIMB(HIP) : 5/5
KNEE: 5/5
ANKLE: 4/5
Medications
• T. ECOSPRIN AV
• T. HAPSIP
• T.THYRONORM 100 ug
• T. PAN 40 mg
• Along with regular physiotherapy

26. LIFE STYLE MODIFICATION AND PATIENT COUNSELING
Physiotherapy :
• Daily physiotherapy can help restore movements, mobility, sensation in the affected area limbs.
• It helps to maintain and build strength in the affected muscles and helps reataining the nerves and muscles.
 Maintain healthy diet.
 Maintain blood pressure.
 Avoid smoking and alcohol completely.
VATA-PACIFYING DIET :
• Eat light meals that are easily digestable and pick worm foods over cold food .
• Avoid barley, rye and millet.
• Include beets, asparagus, okra and carrots in your diet.
• Avoid bitter and pungent flavors, but pick food that is sweet, sour or salty to balance the body.

28. • AYURVEDIC MASSAGE :
• Warm herbal oils are used to avoid re-attack of
the paralytic condition .
• Abhyanga ayurvedic massages ,padhabhyanga
and pizhichil (herbal oil bath therapy) .
• Ayurvedic medications : ashwangandha churna,
castor oil, chopcheeni churna.
• Drinking 20-40ml of radish oil BD and mixture of
black pepper powder + sunti + honey helps to
cure paralytic condition .

29. REFERENCE
• www.researchgate.net
• www.drugs.com
• www.jnnp.bmj.com
• www.healthline.com
• www.medicalnewstoday.com
• www.drugbank.com
• www.paracto.com
• www.medlinepluse.com

30. THANKING YOU